Physical Therapy Utilization Within 90 Days of Total Ankle Arthroplasty

Abstract

Category: Ankle; Arthroscopy; Other Introduction/Purpose: Physical therapy (PT) following total ankle arthroplasty (TAA) is often considered, but guidelines for its use are not standardized. While there may be patient factors that dictate recommendations, establishing a baseline of utilization practices may set the stage for establishing generalizable recommendations. Methods: This retrospective cohort study employed data from the 2010 to 2019 M91Ortho PearlDiver administrative dataset. Those undergoing TAA were identified based on coding, and patient factors were extracted, including: age, sex, Elixhauser Comorbidity Index (ECI), region of the country in which patients' surgery was performed (midwest, northeast, south, west), and insurance plan (commercial, Medicaid, Medicare). The incidence, timing, and frequency of PT utilization in the 90-days following TAA were identified as occurring at home or in an outpatient setting. Univariate and multivariate logistic regression analyses allowed the identification of predictive factors for PT utilization. Results: Of 6,563 TAA patients identified, 2788 (42.5%) utilized postoperative PT services. Most services were done as an outpatient (63.4%), compared to at home (6.1%). Weekly utilization of PT was greatest in the first week following surgery (17.7% of those who utilized PT) and thereafter followed a roughly bell-shaped curve of utilization with the greatest incidence at seven weeks following surgery (14.9% of those who utilized PT). Multivariate analysis identified multiple predictors of PT utilization following TAA, including: older age (odds ratio [OR] 1.23 per decade increase, p < 0.0001), higher ECI (OR 1.03 per 2-point increase, p = 0.0383), having surgery performed in the midwest, northeast, or western US (relative to the South OR 1.43, p < 0.0001; 1.20, p = 0.0109; and 1.32, p < 0.0001, respectively), and having commercial or Medicaid insurance coverage (relative to Medicare OR 1.96, p < 0.0001 and 1.62, p = 0.0006, respectively). Conclusion: Of 6,563 TAA patients, 42.5% utilized PT within 90 days of surgery. PT utilization was highest in the first- and seventh weeks following surgery, and demographic predictors of PT use were defined. Through identification of timing and predictors of PT utilization following TAA, algorithms for PT usage may be better defined and consistently employed.